October 1977

Mixed Connective Tissue Disease

Arch Intern Med. 1977;137(10):1484. doi:10.1001/archinte.1977.03630220108028

To the Editor.—  A controversy seems to have arisen over the nature of mixed connective tissue disease (MCTD) of Sharp. Some consider this to be a true entity that is characterized by a variable but yet defined clinical picture, speckled-pattern fluorescent antinuclear antibody, and the presence, in a high titer, of antibodies to a ribonucleoprotein (RNP) that is saline extractable from nuclei (ENA).1 Others point out that the individual clinical characteristics, such as Raynaud's phenomenon, arthritis and myositis, may all occur in systemic lupus erythematosus (SLE). This has led to the current controversy, and a recent editorial in the New EnglandJournal of Medicine has questioned whether MCTD is simply a subclass of SLE, with the milder clinical picture related to the presence of RNP-RNP antibodies, rather than a distinct entity.2Most articles published on this subject have been written by internists and rheumatologists. As dermatologists, we have

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